特发性马蹄内翻足治疗后步态的纵向回顾：2岁和5岁时的步态分析

A Longitudinal Review of Gait Following Treatment for Idiopathic Clubfoot: Gait Analysis at 2 and 5 Years of Age.

作者信息

Jeans Kelly A, Erdman Ashley L, Jo Chan-Hee, Karol Lori A

机构信息

Texas Scottish Rite Hospital for Children, Dallas, TX.

出版信息

J Pediatr Orthop. 2016 Sep;36(6):565-71. doi: 10.1097/BPO.0000000000000515.

DOI:10.1097/BPO.0000000000000515

PMID:25985372

Abstract

BACKGROUND

Initial correction following nonoperative (NonOp) treatment for idiopathic clubfoot has been reported in 95% of feet by age 2; however, by age 4, approximately one third of feet undergo surgery due to relapse. The purpose of this study was to assess the longitudinal effect of growth and surgical (Sx) intervention on gait following NonOp and Sx treatment for clubfoot.

METHODS

Children with idiopathic clubfoot were seen for gait analysis at 2 and 5 years of age. Kinematic data were collected at both visits, and kinetic data were collected at age 5 years. Group comparisons were made between feet treated with the Ponseti casting technique (Ponseti) and the French physical therapy method (PT) and between feet treated nonoperatively and surgically. Comparisons were made between feet treated with a limited release or tendon transfer (fair) and those treated with a full posteromedial release (poor). The α was set to 0.05 for all statistical analyses.

RESULTS

Gait data from 181 children with 276 idiopathic clubfeet were collected at both age 2 and 5 years. Each foot was initially treated with either the Ponseti (n=132) or PT (n=144) method but by the 5-year visit, 30 Ponseti and 61 PT feet required surgery. Gait outcomes showed limitations primarily in the Sx clubfeet. Normal ankle motion was only present in 17% of Ponseti and 21% of PT feet by age 5 following Sx management. Sx PT feet showed persistent intoeing at age 2 and 5. Within the Sx group, feet initially treated with PT had a clinically significant reduction in ankle power compared with those treated initially by the Ponseti method. Feet treated with posteromedial releases had significantly less ankle power than those treated with limited surgery or that remained NonOp at 5 years.

CONCLUSIONS

This longitudinal study shows subtle changes between 2 and 5 years, and continues to support a NonOp approach in the treatment of clubfoot.

LEVEL OF EVIDENCE

Level II-therapeutic.

摘要

背景

据报道，特发性马蹄内翻足非手术治疗后的初始矫正在2岁时95%的足部得以实现；然而，到4岁时，约三分之一的足部因复发而接受手术。本研究的目的是评估生长和手术干预对马蹄内翻足非手术和手术治疗后步态的纵向影响。

方法

对患有特发性马蹄内翻足的儿童在2岁和5岁时进行步态分析。两次就诊时均收集运动学数据，5岁时收集动力学数据。对采用庞塞蒂石膏技术（庞塞蒂法）和法国物理治疗方法（PT法）治疗的足部以及非手术和手术治疗的足部进行组间比较。对采用有限松解或肌腱转移（尚可）治疗的足部与采用完全后内侧松解（较差）治疗的足部进行比较。所有统计分析的α值设定为0.05。

结果

在2岁和5岁时收集了181名患有276只特发性马蹄内翻足儿童的步态数据。每只脚最初采用庞塞蒂法（n = 132）或PT法（n = 144）进行治疗，但到5岁复诊时，30只采用庞塞蒂法治疗的脚和61只采用PT法治疗的脚需要手术。步态结果显示主要在接受手术治疗的马蹄内翻足中有局限性。在接受手术治疗后到5岁时，仅17%采用庞塞蒂法治疗的脚和21%采用PT法治疗的脚具有正常的踝关节活动。采用PT法手术治疗的脚在2岁和5岁时显示持续的内旋。在手术治疗组中，与最初采用庞塞蒂法治疗的脚相比，最初采用PT法治疗的脚在踝关节力量方面有临床显著降低。采用后内侧松解治疗的脚在5岁时的踝关节力量明显低于采用有限手术治疗或仍未接受手术治疗的脚。